DGA-PRODUCERPENSION & HEALTH Spotlight

ON BENEFITSWINTER 2020

New Premium-Free Benefi t Created for Eligible ParticipantsFor those who lost Earned Ac ve Coverage on June 30th, September 30th or December 31st, 2020, the Board of Trustees has created the Bronze Plus Plan as an alterna ve to COBRA Con nua on Coverage.

Recognizing the pandemic’s con nued impact on produc on, the Board of Trustees has created a new limited benefi t plan in order to con nue to be able to provide premium-free health benefi ts for eligible par cipants who lost Earned Ac ve Coverage in 2020. The premium-free coverage is called the Bronze Plus Plan and includes the

same level of coverage as the DGA Bronze Plan COBRA benefi t, except it also provides prescrip on drug benefi ts.

The new Bronze Plus Plan will provide coverage for the period January 1, 2021 to March 31, 2021 only, as an alter-na ve to COBRA Con nua on Coverage. It is only available to those par cipants for whom the DGA-Producer Health Plan is their primary coverage, and who lost their Earned Ac ve Coverage on June 30th, September 30th, or

December 31st, 2020.

Qualifying par cipants will have the choice of choosing either the: (1) premium-free Bronze Plus Plan or (2) COBRA Con nua on Coverage by paying the applicable premium amount.

Who qualifi es for the premium-free Bronze Plus Plan option?To qualify for the premium-free Bronze Plus Plan, you must meet the following criteria:

Any one of the following:

You had Earned Ac ve Coverage that terminated June 30, 2020.* You had Earned Ac ve Coverage that terminated September 30, 2020.* You have Earned Ac ve Coverage that terminates on December 31, 2020.

*Regardless of any periods of premium-free COBRA Con nua on Coverage off ered a er Earned Ac ve Coverage terminated.

AND:

The DGA-Producer Health Plan is your primary coverage.

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DEPARTMENT DIRECTORYParticipant Services(323) 866-2200, Ext. 401

myPHP SupportmyPHP-support@dgaplans.org(323) 866-2200, Ext. 409

Health Plan Eligibilityeligibility@dgaplans.org(323) 866-2200, Ext. 502

Pensionpension@dgaplans.org(323) 866-2200, Ext. 404

Address Changeaddresschange@dgaplans.org(323) 866-2200, Ext. 407

Contributions and Compliance(323) 866-2200, Ext. 567

COMMUNICATIONS STAFFDeLon Howell, Communica ons EditorPeggy Bo ger, Staff Editorcommunica ons@dgaplans.org

ABOUT THE PLANSThe Pension and Health Plans were created as a result of the Directors Guild of America’s collec ve bargaining agree-ments with producer associa ons repre-sen ng the mo on picture, television and commercial produc on industries. The DGA-Producer Pension and Health Plans are separate from the Directors Guild of America and are administered by a Board of Trustees made up of DGA representa- ves and Producers’ representa ves.

SpotlightON BENEFITS

Volume 28 | Number 2 | Fall 2020

MAILING ADDRESS5055 Wilshire Boulevard, Suite 600Los Angeles, CA 90036

MAIN OFFICE NUMBERS(323) 866-2200(877) 866-2200 - Toll Free

OFFICE HOURSMonday-Friday, 8:30 a.m. to 5:00 p.m.

How is the Bronze Plus Plan different from COBRA Continuation Coverage?The premium-free Bronze Plus Plan is diff erent from COBRA Con nua on Coverage in several key ways.

Premium-Free Bronze Plus Plan COBRA Con nua on Coverage

Premium Amount None. You must pay the premium amount applicable for the level of coverage you elected.

Choice of Plans None.

Your coverage will be set at the DGA Bronze Plan level and includes pre-scrip on drug coverage. Refer to the table at the bo om for details about the Bronze Plus Plan op on.

You are given a choice of Self-Pay plans at or below the coverage level you had at the me your Earned Coverage terminated.

Dura on Eff ec ve January 1, 2021 through March 31, 2021, and will not run con-current with your COBRA Con nua on Coverage eligibility. This means you will be eligible to elect or resume COBRA Con nua on Coverage at the applicable premium a er your pre-mium-free Bronze Plus Plan terminates on March 31, 2021.

For example, par cipants who lost Earned Ac ve Coverage on June 30, 2020 will have had 6 months of premium-free COBRA Con nua on Coverage when the Bronze Plus Plan is off ered. If you elect the premium-free Bronze Plus Plan, you will s ll have 12 months of self-pay COBRA Con nua on Coverage remaining when the premium-free coverage terminates.

Generally, a total of 18 months, including any periods of premium-free COBRA Con nua on Coverage approved by the Health Plan’s Board of Trustees.

Dependents Eligible spouse and dependent child(ren) are covered provided the Health Plan is their primary plan.

Eligible spouse and dependent child(ren) are covered provided the applicable premium for the level of coverage elected is remi ed.

What is covered under the premium-free Bronze Plus Plan?Like the current DGA Bronze Plan, the premium-free Bronze Plus Plan will have higher cost-sharing amounts (co-insurance, deduc ble and out-of-pocket limits) compared to the other Self-Pay plans. Unlike the current DGA Bronze Plan, however, this premium-free coverage will also include prescrip on drug coverage. The premium-free Bronze Plus Plan is summarized below:

MEDICAL COVERAGE

Network Provider Non-Network Provider

Calendar Year Deduc ble $750 per person$2,250 per family

$750 per person$2,250 per family

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Network Provider Non-Network Provider

Percentage Payable 70% of Covered Expenses

*Essen al health benefi ts listed under the Pa ent Protec on and Aff ordable Care Act are covered at 100%

50% of Reasonable and Customary Charges

Calendar Year Out-of-Pocket Maximum

$8,550 per person$17,100 per family

$12,500 per person

What’s Not Included with this Coverage

· Vision;· Dental; and· Special arrangements with UCLA Health/EIMG

PRESCRIPTION COVERAGE

Co-Payments for Up to 30-day supplies from Par cipa ng Retail Pharmacies

Up to 90-day supplies from the Express Scripts Pharmacy or Walgreens1

Generic Drugs $10 $25

Brand Name Drugs $24 $60

Lifestyle Drugs2 Greater of $40 or 50% of the cost of the medica on

Greater of $60 or 50% of the cost of the medica on

1The Plan par cipates in a Smart90 Walgreens program with Express Scripts. Smart90 Walgreens allows pa ents to obtain up to two 30-day fi lls of their maintenance medica on at any par cipa ng retail pharmacy. A er these two fi lls are exhausted, pa ents must pay the full cost for their prescrip on unless they transi on their maintenance medica on to Walgreens or the Express Scripts Pharmacy for a 90-day supply. Acute medica ons may be fi lled at any par cipa ng retail pharmacy.

2Erec le dysfunc on drugs, proton pump inhibitors, and sleep aids are covered under the Lifestyle Drug er; in certain cases, these drugs require a coverage review.

How do I elect the premium-free Bronze Plus Plan?The procedures for elec ng the premium-free Bronze Plus Plan op on will depend on when your Earned Ac ve Coverage terminated as follows:

If your Earned Ac ve Coverage terminated June 30 or September 30, 2020: When your period of premium-free COBRA Con nua on Coverage ends on December 31, 2020, you will be off ered the op on to either: (1) elect the pre-mium-free Bronze Plus Plan, or (2) elect to con nue your COBRA Con nua on Coverage at the applicable premium for the level of coverage you choose. If you enroll in the premium-free Bronze Plus Plan, you will have the op on to resume your remaining paid COBRA Con nua on Coverage once the premium-free cov-erage terminates on March 31, 2021.

If your Earned Ac ve Coverage terminates December 31, 2020: Your Open Enrollment materials will off er the op on of elec ng either: (1) the premium-free Bronze Plus Plan, or (2) COBRA Con nua on Coverage at the applicable premium for the level of coverage you choose. If you enroll in the premium-free Bronze Plus Plan, you will have the op on to start your COBRA Con nua on Coverage once the premium-free coverage terminates on March 31, 2021.

For more informa on, contact the Eligibility Department at (323) 866-2200, Ext. 502 or eligibility@dgaplans.org. PH

COVID-19 Vaccine Availability and Distribution: What We Know So Far

It is an cipated that the Food and Drug Administra on will soon approve a COVID-19 vaccine.

Na onwide distribu on is expected to begin in mid-December to pri-ori zed communi es. While details about this process are not yet fi nal-ized, here is what we know so far:

It is an cipated the following communi es will be priori zed for ini al vaccina ons:

◊ Healthcare personnel;

◊ Non-healthcare essen al workers;

◊ Adults with high-risk medical condi ons and risk factors for severe COVID-19 illness; and

◊ People aged 65 years and older (including those living in long-term care facili es).

Children are unlikely to have a vaccine available un l later in 2021.

Most health plans will be required to cover vaccina on and related administra on costs without cost sharing (i.e., deduct-ibles, co-pays, co-insurance and prior authoriza ons), regard-less of whether administered by a network or non-network provider.

As more details about vaccine distri-bu on and how the vaccine will be covered by insurers become avail-able, it will be posted on our website at www.dgaplans.org/coronavirus-resources-and-updates. PH

MEDICAL COVERAGE (con nued)

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4

Incremental Increases to EarningsThreshold for Pension Plans’

Credited Service Months (CSMs)

Credited Service Months (CSMs) refl ect your DGA-covered service in the Pension Plans and are used in both the Basic and

Supplemental Pension Plans to determine ves ng status. For the Basic Pension Plan, CSMs are also used along with your earnings to determine the amount of your monthly benefi t. You earn CSMs based on your reportable earnings during a calendar year and can earn a maximum of 12 CSMs in any year.

Currently, for the 2020 Plan Year, a par cipant will accrue one CSM per $3,600 in reportable earnings. Beginning January 1,

2021 and con nuing through January 1, 2023, the earnings threshold required to earn one CSM will increase as follows:

Please note these changes are based on the recently nego ated increases to the minimum earnings require-ments under the appli-cable Collec ve Bargaining Agreements. For more informa on, please refer to the enclosed no ce to Plan par cipants and Alternate Payees.

For more informa on on how CSMs aff ect your pension, refer to the March 2020 Pension Plans Summary Plan Descrip on available at dgaplans.org /Pension-Plans-SPD. PH

New Credited Service Months Earnings Requirements

Time Period Requirement to Earn One Credited Service Month

2021 $3,700

2022 $3,800

2023 $3,900

Express Scripts’ Changes to List of Covered Medications Taking Effect January 1, 2021

Express Scripts, the Health Plan’s prescrip on drug benefi t manager, periodically reviews its list of covered medica ons (called the Na onal Preferred Formulary) to ensure access to safe, eff ec ve treatments in all drug classes. As new medica ons enter the market,

they are reviewed in consulta on with an independent group of physicians to determine which provide signifi cant health benefi ts beyond other available op ons. Certain medica ons may be excluded from the formulary when clinically equivalent alterna ves are available and off er signifi cant cost savings. Changes to the formulary aff ect which medica ons will be covered by the DGA Producer-Health Plan and how much you pay out of pocket for prescrip ons.

Eff ec ve January 1, 2021, Express Scripts is revising its list of covered medica ons. If you are cur-rently taking a medica on that will be excluded from the revised formulary, Express Scripts should

have already no fi ed you via mail with informa on on alterna ves. If you are taking a maintenance medi-ca on, be sure to review the new list in case the status of your medica on has changed.

The complete 2021 list of excluded medica ons along with preferred alterna ves is available at h ps://www.express-scripts.com/art/open_enrollment/DrugListExclusionsAndAlterna ves.pdf. For informa on on whether this change will aff ect your current prescrip ons, log on to your Express Scripts account at expressscripts.com. If you have any ques ons, please call Express Scripts at (800) 987-7828. PH

5

Home Testing Kits Grow in Popularity But May Not Be Covered By the Health Plan

Home tes ng kits have grown in popularity in recent years, beginning with widely used gene cs services like 23andMe and Ancestry.com. As interest in home tes ng

kits has grown, the market has exploded accordingly, with companies now off ering home tes ng kits for a host of medical condi ons like STDs, vitamin defi ciencies, HIV, pregnancy, cho-lesterol, thyroid func on and most recently, COVID-19.

As the public con nues to embrace this technology, the accu-racy, appropriateness and costs of these tests have come under increased scru ny from both government agencies and private insurers. While the Health Plan takes no posi on regarding the validity of specifi c home tes ng kits, Health Plan par cipants should know the circumstances under which these tests might be covered under the Health Plan.

Please remember that the Health Plan covers Medically Necessary visits, treatments and procedures for you and your eligible dependents, including laboratory and diagnos c tests and services ordered by a physician to treat sickness or injury. All care must be considered Medically Necessary, excluding covered preven ve care services, to be covered under the Health Plan.

When it comes to home tes ng kits, like all other tes ng—including tes ng for COVID-19—one important metric for determining whether it may be covered under the Health Plan, is whether the test has been ordered by an a ending licensed physician or healthcare provider, and it was not ordered solely to sa sfy the curiosity of the par cipant or the par ci-pant’s physician, hospital, or other health care provider. The Health Plan considers a treatment, service or supply Medically Necessary when the treatment:

Is consistent with generally accepted medical prac ce within the medical community for the diagnosis or direct

care of symptoms, sickness or injury of the pa ent, or for rou ne screening examina on under wellness benefi ts, where and at the me the treatment, service or supply is rendered. The determina on of “generally accepted medical prac ce” is the preroga ve of the Health Plan through consulta on with appropriate authorita ve medical, surgical, or dental prac oners;

Ordered by the a ending licensed physician (or, in the case of dental services, ordered by the den st), and not solely for the convenience of the par cipant or the par ci-pant’s physician, hospital or other health care provider;

Consistent with professionally recognized standards of care in the medical community with respect to quality, frequency and dura on; and

The most appropriate and cost-effi cient treatment, service or supply that can be safely provided, at the most cost-effi cient and medically appropriate site and level of service.

It is important to understand the defi ni on of medical necessity before you purchase and use a home tes ng kit. Understanding this standard will help you avoid surprise costs for tests that are not covered. Unless the test meets all four of the aforemen- oned requirements, it will likely not be covered, leaving you to

pay the cost out of pocket.

For details about the medical necessity standard, refer to the 2020 Health Plan Summary Plan Descrip on, pages 114-115, and its updates or speak to a Par cipant Services Representa ve at toll-free at (323) 866-2200, Ext. 401 or (877) 866-2200, Ext. 401. PH

7

Sleep Apnea and Its Effects On Your Health...What You Can Do

It’s amazing what a good night’s sleep can do for the body and alarm-ing how troublesome a chronic lack of sleep can be. Ge ng adequate

sleep helps reduce stress, increase alertness, and preserve memory, while sleep depriva on has been linked to lost produc vity, higher overall health costs, and a host of serious health condi ons, including depression, anxiety, heart failure, and stroke.

When most people think of good sleep, they tend to focus on the total number of hours of sleep that they get in a day. Just as important, however, is the quality of sleep one experiences. While the amount of sleep that most of us get is manage-able, for 10%-17% of the U.S. popula on, poor quality sleep is a much more serious issue; it is a ma er of health.

Sleep apnea is a disorder in which breath-ing is repeatedly interrupted during sleep, most commonly because of an obstructed upper airway (obstruc ve sleep apnea), though it can also result from the brain’s failure to properly signal the muscles that control breathing (central sleep apnea). Though symptoms of sleep apnea—which include loud snoring, excessive sleepiness during the day, and poor concentra on—can be highly detrimental to one’s quality of life, most cases of sleep apnea go undiag-nosed and untreated.

D S AMost people might not recognize waking up red, falling asleep during the day, or the occasional complaint from their partner that they snore loudly as causes for concern, but when incidents like these are recurrent, it might be me to see a doctor and take a closer look. All of these things could be symptoms of sleep apnea.

Sleep apnea is a treatable medical condi- on that must be diagnosed by your

doctor. It is es mated that 22 million Americans suff er from sleep apnea, although the condi on is more preva-lent among adult males aged 40 to 70, individuals who are obese, and individu-als with other health condi ons, such as heart failure or stroke.

Generally, sleep apnea is diagnosed through a ques onnaire followed by a sleep study (either in a sleep lab or at home using a portable device). The “gold standard” for sleep apnea tes ng and diagnosis is the a ended sleep study, or polysomnography (PSG) tes ng, in which a endants con nuously monitor the pa ent overnight in a hospital or in a sleep lab. PSG tes ng involves recording a pa ent’s brain ac vity, eye movement, heartbeat, muscle movements, oxygen satura on, respiratory eff ort, and airfl ow, in order to obtain a comprehensive

assessment of how the pa ent’s body changes as they sleep. Non-PSG sleep monitoring is usually conducted with portable devices in a home se ng and without an a endant present. Non-PSG tes ng typically only includes some of the measurements recorded during PSG tes ng, but they are o en suffi cient to make a diagnosis.

If a pa ent is diagnosed with sleep apnea, the severity of their condi on is determined by an analysis of the average number of mes per hour their breathing briefl y stops (apneic episodes) and any corresponding reduc on of the volume of air moving in and out of their lungs (hypopneic episodes). From this data, your doctor can prescribe a suitable course of treatment.

The Health Plan covers both a ended sleep studies (PSG tes ng) and at-home sleep studies with portable monitor-ing devices (non-PSG tes ng), as long as such treatment is recommended by your trea ng physician for the analysis of suspected sleep apnea and considered medically necessary under the terms of the Health Plan. Please note the Health Plan does not cover related services per-formed in conjunc on with sleep studies for sleep disorders. The Health Plan’s medical necessity standard is set forth in the Glossary of the DGA-Producer Health

6

Plan Summary Plan Descrip on (“SPD”). The Health Plan SPD and all updates are available online at www.dgaplans.org. If you would like a hard copy, please let us know and we will mail you one at no cost.

T S A

PAP TherapyPosi ve airway pressure, or PAP, is the most common treatment for severe sleep apnea. Posi onal therapy, non-surgical weight loss or bariatric surgery might also be used for pa ents who cannot tolerate or have been deemed non-responsive to other therapies.

PAP works by providing posi ve pressure into the pa ent’s airways through a mask or nosepiece, so that they remain open throughout sleep. There are three types of PAP therapies, named according to the way air pressure is regulated:

CPAP, or con nuous posi ve airway pressure, is the most common type of PAP therapy, and it delivers air at a con- nuous pressure;

APAP, or auto- tra ng posi- ve airway pressure, auto-

ma cally raises or lowers air pressure as needed through-out the night; and

BPAP, or bi-level posi ve airway pressure, alternates the air pressure depending on whether the user is exhal-ing or inhaling.

Your doctor may prescribe any of these PAP therapies, taking into account your previous PAP experience and any other underlying condi ons you may have. Regardless of the type prescribed, however, PAP therapy has been found to be highly eff ec ve when adhered to consistently.

The Health Plan covers PAP machines when they are prescribed by your doctor, considered medically necessary under the terms of the Plan, and sa sfy the Plan’s coverage requirements for durable medical equipment. In the case of rented PAP machines, the Health Plan will request a copy of your doctor’s prescrip- on to confi rm these condi ons have

been sa sfi ed, which must include the frequency and dura on that the machine is to be used.

Custom Sleep AppliancesFor pa ents who are diagnosed with mild obstruc ve sleep apnea or who are PAP intolerant, the doctor may prescribe a custom oral sleep appliance in lieu of PAP therapy. Custom sleep devices adjust your mouth and tongue in a manner that prevents upper airway collapse and have been found to be eff ec ve in many cases

of obstruc ve sleep apnea. If your doctor prescribes a custom sleep device, it is recommended that you request a prede-termina on of coverage from the Health Plan before fi lling your prescrip on.

A predetermina on is a wri en analy-sis, provided by the Health Plan upon request, which evaluates the medical necessity of a par cular procedure or treatment before you receive it. A pre-determina on will provide you with infor-ma on on how the Health Plan might

apply benefi ts for the service in ques on; though it does not guaran-tee coverage. A fi nal determina on of coverage can be made only a er the procedure has been performed, upon processing the claim and reviewing addi onal informa on and records submi ed.

When reques ng a predetermina- on for a custom sleep device, the

Health Plan will request the sleep study results confi rming your sleep apnea diagnosis and the specifi c product descrip on of the custom oral appliance your doctor has prescribed. Within 10 business days following receipt of your predetermi-na on request, the Health Plan will send you or your provider a wri en response outlining the results of the predetermina on. The predeter-mina on will indicate whether the specifi ed procedure codes included in your request refl ect medical necessity.

Undiagnosed sleep apnea has been proven to lead to increased doctor

visits, more frequent and longer hospital stays and greater health care costs. If you or a loved one is experiencing chronic unexplained sleepiness during waking hours, snoring, fa gue, insomnia or unre-freshing sleep, it may be me to see your doctor for further evalua on. PH

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All-Inclusive Out-of-Pocket Limits Increase, Effective January 1, 2021 as Established Under the Affordable Care Act

The All-Inclusive Network Out-of-Pocket Limit sets a maximum on the amount you pay out of pocket per calendar year for network benefi ts, including

deduc bles, co-insurance and co-payments (such as pre-scrip on drug co-payments, the $50 emergency room co-payment and the $10 co-payment for visits to the UCLA/MPTF health centers). The Health Plan indexes this limit annually, in line with the amount established each year under the Aff ordable Care Act.

Accordingly, beginning January 1, 2021, the Health Plan’s All-Inclusive Network Out-of-Pocket Limit will increase from $8,150 individual/$16,300 family to $8,550 individ-ual/$17,100 family for all coverage plans. If you reach the limit, the Health Plan will pay 100% of covered network expenses. PH